Claims Head - Oneplan, Gauteng

  • Gauteng
  • Salary: Market Related
  • Benefits: Health Insurance, Group Risk
  • Job Type: Permanent
  • Sectors: Insurance, Medical
  • Posted by Oneplan on Friday, July 12, 2019
  • Reference: 1581514
  • Apply before Tuesday, September 10, 2019 - 52 Days left

Vacancy Details

Employer: Oneplan

We are looking for a dynamic and passionate Claims Manager to join our team.

Duties will include but not be limited to;

·         Effectively implement and manage underwriting protocols to limit risk

·         Review loadings based on financial risk with application

·         Manage change in health status and amend accordingly

·         Maintain, analyse and make appropriate changes to ensure                              maintenance of claims ratios

·         Supply and maintain competitor analysis and ensure that premiums and            product are market related

·         Become product knowledge expert and advise on relevant product                    development and amendments

·         Assist with implementing risk protocols/ policy wording

·         Maintain and train staff on internal SOP’s to ensure consistency and                  accuracy in respect of policy changes/updates

·         Compile underwriting strategy in conjunction with premium development

·         Ensure that all corrections are done timeously and accurately in line                  with “live” underwriting turnaround times

·         Ensure underwriting processes align with all audit requirements

·         Manage Hospital authorisation and claims process

·         Review Authorisations

·       Case Management audits

·       Staff coaching and SOP training

·       Attend to after-hours authorisations queries

·      Support Auth’s team when volumes dictate

·      Advise on clinical protocols as required, based on terms and conditions

·      Ensure events and claim limit linked correctly

·      Manage client/ provider satisfaction

·      Build and maintain relationships with relevant providers/ stakeholders

·      Manage ex-gratia request process

·      Assist with ombudsman complaints

·      Oversee and investigate fraud and report all cases to the Compliance                 Department

·      Deliver sanction and coach staff according to feedback

Candidate Requirements


·         Grade 12/Matric (Essential)

·         Relevant Medical qualification (preferred) – Nursing Degree/Doctorate

·         FAIS Credits – 120 Credits (Preferred)

·         RE5 Regulatory Exam



·         A Minimum of 5 years Medical industry experience (preferred)

·         Claims and Underwriting experience (essential)

·         Risk management history


·         MS Office including Word, Excel, Outlook and Power Point


·         Ability to deal with multiple projects at any given time, strong                          multitasker

·         Excellent time management

·         Excellent People Management

·         Problem solving skills 

·         Excellent Report writing skills

·         Excellent customer service skills, both internally and externally

·         Accuracy and high attention to detail

·         Ability to overcome objections – external and internal

·         Honesty, business ethics and high accountability


·         Confident and enjoy people interaction

·         Self-driven and disciplined

·         Friendly and approachable

·         Pro-active thinking

·         Analytical, fact-based, logical

·         Positive attitude and ability to motivate peers and staff

·         Able to think logically and able to improvise, be innovative

·         Able to communicate well, orally and in writing

·         Organised and able to work under pressure, gain control of situations,              and able to overcome objections

This position reports to: Financial Director Apply before Tuesday, September 10, 2019 - 52 Days left Companies may expire jobs at their own discretion. If you have not received a response within two weeks, your application was most likely unsuccessful.
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